Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector4282310.17816/RA42823ArticlesСтатьиResearch ArticlePain syndrome after laparoscopic cholecystectomyБолевой синдром после лапароскопической холецистэктомииSviridovSergey V.СвиридовСергей Викторович

MD, PhD, DSc, Professor, Director of the Department of Anesthesiology and Critical Care Medicine, N.I. Pirogov Russian National research medical University

д.м.н., профессор, заведующий кафедрой анестезиологии, реаниматологии и интенсивной терапии, ГБО ВПО «Российский научно-исследовательский медицинский университет им. Н.И. Пирогова МЗ РФ»

sergey.sviridov.59@mail.ruVedeninaI. VВеденинаИ. ВTaylorS. DТейлорС. ДN.I. Pirogov Russian National Research Medical UniversityГБО ВПО «Российский научно-исследовательский медицинский университет им. Н.И. Пирогова МЗ РФ»15122016104VOL 10, NO4 (2016)ТОМ 10, №4 (2016)26227224082020Copyright ©; 2016, Eco-VectorCopyright ©; 2016, ООО "Эко-Вектор"2016Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/42823

Laparoscopic cholecystectomy is the «gold» standard for the surgical treatment of patients with calculous cholecystitis. It is believed that laparoscopic cholecystectomy is not only safe, but also is painless in the postoperative period. At the same time the pain syndrome after laparoscopic cholecystectomy may be very serious. The article discusses the formation and localization of the pain syndrome, diagnostics and pharmacotherapy of the pain syndrome after laparoscopic cholecystectomy.

Лапароскопическая холецистэктомия (ЛХЭ) является золотым стандартом хирургического лечения больных калькулезным холециститом. Сложилось представление, что ЛХЭ не только безопасна, но и безболезненна в послеоперационном периоде. В то же время болевой синдром (БС) после ЛХЭ может быть выраженным. В статье обсуждаются вопросы формирования и локализации болевого синдрома, диагностика и фармакотерапия БС после ЛХЭ.

pain syndromelaparoscopic cholecystectomyболевой синдромлапароскопическая холецистэктомияМехтиева О.А., Богданов Р.Н. Мехтиев С.Н. Алгоритм ведения пациентов с желчнокаменной болезнью. Лечащий врач. 2011; 2: 22-8.Скворцова Т.Э., Ситкин С.И., Радченко В.Г., Селиверстов П.В.,Ткаченко Е. И. Желчнокаменная болезнь. Современные подходы к диагностике, лечению и профилактике: пособие для врачей. М.: Форте принт. 2013. 32 с.Ильченко А.А. Болезни желчного пузыря и желчных путей: Руководство для врачей. 2-е изд., перераб. и доп. М.: ООО «Издательство «Медицинское информационное агентство». 2011. 880.Фролов Я.А., Литвинова Н.В., Волошина Н.Б. Динамика билиарных болей после холецистэктомии. Сибирское медобозрение. 2011; 70 (4): 23-7.Hashemi S., Heydari S., Hashemi S. Paravertebral block using bupivacaine with/without fentanyl on postoperative pain after laparoscopic cholecystectomy: A double-blind, randomized, control trial. Adv. Biomed Res. 2014 Sep; 4 (3): 187.Lin S., Hua J., Xu B., Yang T., He Z., Xu C., Meng H., Zhou B., Song Z. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy: a randomized controlled trial. Int. J. Clin. Exp Med. 2015 Aug; 15; 8 (8): 13824-9.Singla S., Mittal G., Raghav, Mittal R.K. Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumoperitoneum. J. Clin. Diagn. Res. 2014 Feb; 8 (2): 92-4.Mohtadi A., Nesioonpour S., Salari A., Akhondzadeh R., Masood Rad B., Aslani S.M. The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy. Anesth. Pain Med. 2014 Aug; 13; 4 (3): e 17872.Hwang B.Y., Kwon J.Y., Kim E., Lee D.W., Kim T.K., Kim H.K. Oxycodone vs. fentanyl patient-controlled analgesia after laparoscopic cholecystectomy. Int. J. Med. Sci. 2014 Apr; 30; 11 (7): 658-62.Sharma J., Bijalwan A., Atif Beg M., Dutta S., Bawa S., Anjoom M. Effect of gabapentin in postoperative pain, nausea, and vomiting in patients undergoing laparoscopic cholecystectomy. Int. J. Med. Sci. Public Health. 2015; 4 (4): 565-8.Amini S., Sabzi Sarvestani A. Comparing the impact of intraperitoneal hydrocortisone with bupivacaine on postoperative pain after laparoscopic cholecystectomy. Anesth. Pain Med. 2014 Sep 8; 4 (4): e17206.Fanelli A., Ghisi D, Pergolotti B, Martinotti M, Fanelli G, Danelli G. Pilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph®) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol. 2014 Jan; 80 (1): 66-75.Ortiz J., Chang L.C., Tolpin D.A., Minard C.G., Scott B.G., Rivers J.M. Randomized, controlled trial comparing the effects of anesthesia with propofol, isoflurane, desflurane and sevoflurane on pain after laparoscopic cholecystectomy. Braz. J. Anesthesiol. 2014 May-Jun; 64 (3): 145-51.Esmat I.M., Farag H.M. Comparative study between paracetamol and two different doses of pregabalin on postoperative pain in laparoscopic cholecystectomy. Saudi J. Anaesth. 2015 Oct-Dec; 9 (4): 376-80.Agarwal A., Batra R.K., Chhabra A., Subramaniam R., Misra M.C. The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. Saudi J. Anaesth. 2012; 6: 344-9.Barthelsson C., Sandblom G., Ljesevic-Nikoletic S., Hammarqvist F. Effects of Intra-abdominally Instilled Isotonic Saline on Pain, Recovery, and Health-Related Quality-of-Life Following Laparoscopic Cholecystectomy: A Randomized Prospective Double-Blind Controlled Study. World. J. Surg. 2015 Jun; 39 (6): 1413-20.Sabzi Sarvestani A., Zamiri M. Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesth. Pain Med. 2014 Sep 14; 4 (4): e17366.Guo S., Duan G., Wang J., Chi X., Zhang L., Zhang X. Comparison of sufentanil-tramadol PCIA between laparoscopic cholecystectomy and gynecological laparoscopy. Zhonghua Wai Ke Za Zhi. 2015 Feb; 53 (2): 150-4.Reddy V.S., Brown J.D., Ku B., Gilchrist B.F., Farkas D.T. Effect of Pain Medication Choice on Emergency Room Visits for Pain after Ambulatory Laparoscopic Cholecystectomy. Am Surg. 2015 Aug; 81 (8): 826-8.Blichfeldt-Eckhardt M.R., Ording H., Andersen C., Licht P.B., Toft P. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain. 2014 Nov; 155 (11): 2400-7.Gurusamy K.S., Vaughan J., Toon C.D., Davidson B.R. Pharmacological interventions for prevention or treatment of postoperative pain in people undergoing laparoscopic cholecystectomy. Cochrane Database Sys.t Rev. 2014 Mar 28;3: CD008261.Arab M., Motahhar H.S., Pazouki A., Tamannaie Z. Efficacy of Diclofenac Rectal Suppository in Patients with Laparoscopic Cholecystectomy: A Prospective Randomized Double Blinded Clinical Trial. J. Minim. Invasive Surg. Sci. 2013 November; 2 (4): 43-5.Kocman I., Krobot R., Premuzić J., Kocman I., Stare R., Katalinić L., Basić-Jukić N. The effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. Acta. Clin. Croat. 2013 Sep; 52 (3): 289-94.Bala I., Bhatia N., Mishra P., Verma G.R., Kaman L. Comparison of preoperative oral acetazolamide and intraperitoneal normal saline irrigation for reduction of postoperative pain after laparoscopic cholecystectomy. J. Laparoeundosc. Adv Surg. Tech. 2015 Apr; 25 (4): 285-90.Yu G., Fu G., Li F., Li L., Guo F., Xue H., He K., Wang J. Efficacy on analgesia with electric stimulation of long-term retaining needle after laparoscopic cholecystectomy. Zhongguo Zhen Jiu. 2014 Feb; 34 (2): 169-72.Kouroukli I., Zompolas V., Tsekoura V., Papazoglou I., Louizos A., Panaretou V. Comparison between lornoxicam quick-release and parecoxib for post-operative analgesia after laparoscopic cholecystectomy: A prospective randomized, placebo-controlled trial. J. Anaesthesiol. Clin. Pharmacol. 2013 Oct; 29 (4): 485-90.Ingelmo P., Bucciero M., Somaini M., Sahillioglu E., Garbagnati A. Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: a double-blind, randomized, placebo-controlled trial. Br. J. Anaesth. 2013 May; 110 (5): 800-6.Shuying L., Xiao W., Peng L., Tao Z., Ziying L., Liang Z. Preoperative intravenous parecoxib reduces length of stay on ambulatory laparoscopic cholecystectomy. Int. J. Surg. 2014; 12 (5): 464-8.Balaban F., Yağar S., Özgök A., Koç M., Güllapoğlu H. A randomized, placebo-controlled study of pregabalin for postoperative pain intensity after laparoscopic cholecystectomy. J. Clin. Anesth. 2012 May; 24 (3): 175-8.Szental J.A., Webb A., Weeraratne C., Campbell A., Sivakumar H., Leong S. Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI®) monitoring: a randomized clinical trial. Br. J. Anaesth. 2015 Apr; 114 (4): 640-5.Lam D.M., Choi S.W., Wong S.S., Irwin M.G., Cheung C.W. Efficacy of Pregabalin in Acute Postoperative Pain Under Different Surgical Categories: A Meta-Analysis. Medicine (Baltimore). 2015 Nov; 94(46): e1944.Mitra S., Khandelwal P., Roberts K., Kumar S., Vadivelu N. Pain relief in laparoscopic cholecystectomy--a review of the current options. Pain Pract. 2012 Jul; 12 (6): 485-96.Agrawal R., Sood K.C., Agarwal B. Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis. Surg. Res. Pract. 2015; 5-7.Овечкин А.М., Ефременко И.В. Фармакотерапия острой послеоперационной боли, основанная на применении препаратов, воздействующих на NMDA-рецепторный комплекс. Анестезиология и реаниматология. 2013; 3: 63-69.Gómez-Vázquez M.E., Hernández-Salazar E., Novelo-Otañez J.D., Cabrera-Pivaral C.E., Dávalos-Rodríguez I.P., Salazar-Páramo M. Effect of endovenous morphine vs. ketorolac on proinflammatory cytokines during postoperative analgesia in laparoscopic cholecystectomy. Cir. 2012; 80 (1): 56-62.Picchio M., Lucarelli P., Di Filippo A., De Angelis F., Stipa F., Spaziani E. Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS, 2014 Oct-Dec; 18(4). pii: e2014.00242. doi: 10.4293/JSLS.2014.00242.Lucarelli P., Picchio M., Martellucci J., De Angelis F., di Filippo A., Stipa F., Spaziani E. Drain After Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis. A Pilot Randomized Study. Indian J. Surg. 2015; 77 (2): 288-92Ko-Iam W., Paiboonworachat S., Pongchairerks P., Junrungsee S., Sandhu T. Combination of etoricoxib and low-pressure pneumoperitoneum versus standard treatment for the management of pain after laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc. 2016; 23. [Epub ahead of print].Овечкин А.М., Ефременко И.В. Габапентин: есть ли место антиконвульсантам в схемах лечения острой послеоперационной боли? (аналитический обзор). Регионарная анестезия и лечение острой боли. 2010; 2 (IV): 5-12.Kotsovolis G., Karakoulas K., Grosomanidis V., Tziris N. Comparison between the combination of gabapentin, ketamine, lornoxicam, and local ropivacaine and each of these drugs alone for pain after laparoscopic cholecystectomy: a randomized trial. Pain Pract. 2015; 15 (4): 355-63.Papathanasiou T., Juul R.V., Heegaard A.M., Kreilgaard M., Lund T.M. Co-administration of morphine and gabapentin leads to dose dependent synergistic effects in a rat model of postoperative pain. Eur. J. Pharm. Sci. 2016; 82: 97-105.Gurunathan U., Rapchuk I.L., King G., Barnett A.G., Fraser J.F. The effect of pregabalin and celecoxib on the analgesic requirements after laparoscopic cholecystectomy: a randomized controlled trial. J. Anesth. 2015 29. [Epub ahead of print].Yadav G., Behera S.S., Das S.K., Jain G., Choupoo S., Raj J. Role of flupirtine as a preemptive analgesic in patients undergoing laparoscopic cholecystectomy. J. Anaesthesiol Clin. Pharmacol. 2015; 31 (2): 169-73.Ryu J., Koo B., Kim B., Oh A. Prospective, randomized and controlled trial on magnesium sulfate administration during laparoscopic gastrectomy: effects on surgical space conditions and recovery profiles. Surg.Endosc. 2016, Mar 11. [Epub ahead of print].Ефременко И.В. Послеоперационная анальгезия на основе комплексного применения неопиоидных анальгетиков и препаратов, воздействующих на N-метил-D-аспартат рецепторный комплекс. Дис. … к. м. н. М., 2016.Choi Y., Shim J., Song J., Kim J., Yoo Y., Kwak Y. Combination of pregabalin and dexamethasone for postoperative pain and functional outcome in patients undergoing lumbar spinal surgery: a randomized placebo-controlled trial. Clin. J. Pain. 2013; 29 (1): 9-14.Buland K., Zahoor M.U., Asghar A., Khan S., Zaid A.Y. Efficacy of single dose perioperative intravenous steroid (dexamethasone) for postoperative pain relief in tonsillectomy patients. J. Coll. Physicians Surg. Pak. 2012; 22 (6): 349-52.Chavarría-Pérez T., Cabrera-Leal C.F., Ramírez-Vargas S., Reynada J.L., Arce-Salinas C.A. Locally administered ropivacaine vs. standard analgesia for laparoscopic cholecystectomy. Rev. Med. Inst. Mex. Seguro Soc. 2015; 53 (3): 274-8.Alper I., Ulukaya S., Yüksel G., Uyar M., Balcıoğlu T. Laparoscopic cholecystectomy pain: effects of the combination of incisional and intraperitoneal levobupivacaine before or after surgery. Agri. 2014; 26 (3): 107-12.Keir A., Rhodes L., Kayal A., Khan O.A. Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic. Int. J. Surg. 2013; 11 (9): 792-4.Basaran B., Basaran A., Kozanhan B. Analgesia and Respiratory Function after Laparoscopic Cholecystectomy in Patients receiving Ultrasound-Guided Bilateral Oblique Subcostal Transversus Abdominis Plane Block: A Randomized Double-Blind Study. Med. Sci. Monit. 2015; 21: 1304-12.Navlet M.G., Garutti I., Olmedilla L., Pérez-Peña J.M., San Joaquin M.T., Martinez-Ragues G. Paravertebral ropivacaine, 0.3%, and bupivacaine, 0.25%, provide similar pain relief after thoracotomy. J. Cardiothorac. Vasc. Anesth. 2006; 20: 644-7.Davies R.G., Myles P.S., Graham J.M. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy: A systematic review and metaanalysis of randomized trials. Br. J. Anaesth. 2006; 96: 418-26.